P1072: SIGNIFICANT PREDICTORS OF DECREASED BONE MINERAL DENSITY IN PATIENTS WITH HODGKIN’S LYMPHOMA
Authors: Mariya Voytko, Tatyana Pospelova, Vadim Klimontov, Jana Shebunyaeva
Journal: HemaSphere (2023)

Topic: 17. Hodgkin lymphoma - Clinical Background: Hodgkin’s lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for skeletal late effects, including low bone mineral density, are not as well recognized across medical disciplines. At the same time, there are currently no prognostic tools for assessing the total risk of developing osteoporosis in patients with HL. In this regard, it is relevant to search for a combination of predictors of decreased BMD in patients with HL for further development of both individual preventive programs and methods of therapeutic interventions. Aims: This study aims to establish the optimal prediction model for osteoporosis risk assessment in patients with HL. Methods: The study evaluated the functioning of the endocrine system in 160 patients with HL (55 male and 105 female) aged 18 to 65 years after chemoradiotherapy. The clinical examination included a biochemical analysis of blood, test of serum hormones (THS, T3, free T4, PTH, FSH, LH, free testosterone, DHEA-S, SHBG) and cytokines (TNF-α, IL-6, IL-4, IL-1β, IL-1RA) by ELISA. BMD was assessed by dual-energy X-ray absorptiometry. Statistical analysis was performed using statistical software IBM SPSS Statistics 26.0 (IBM, USA) and Statistica 13.0 (Dell, USA). Results: Patients with HL were divided into groups with normal BMD (59,4%), osteopenia (18,1%) and osteoporosis (22,5%). The most important and informative clinical, hematological and endocrine predictors of a decrease in BMD in patients with HL were determined by ROC analysis: the use of > 8 courses of polychemotherapy (OR=7,92 (3,49–18,0), p<0.001), the total dose of alkylating cytostatic drugs ≥ 7500 mg (OR=2,34 (1,09–5,01), p=0,03), cumulative glucocorticosteroid dose ≥ 6250 mg (OR=2,96 (1,15–7,62), p=0,025), total dose of cyclophosphamide ≥ 7000 mg (OR=2,62 (1,01–6,80), p=0,047), age over 52 years (OR=114 (10,4–1277), p<0.001), concentration TSH ≥ 1,95 mIU/L (OR=3,11 (1,44–6,72), p=0,004), parathyroid hormone level ≥ 78,6 pg/mL (OR=3,95 (1,61–9,69), p=0,003), free T4 < 11 pmol/l (OR=3,30 (1,53 – 7,12), p=0,002), serum progesterone ≤ 0,90 nmol/l (OR=3,67 (1,46–9,24), p=0,006), FSH ≥ 6,95 mIU/mL (OR=3,39 (1,35–8,53), p=0,009). In patients with newly diagnosed HL, the most significant predictors of osteoporosis formation are serum LDH concentration ≥ 593 U/l (OR=12,6 (2,21–72,0), p=0,004), ESR ≥ 28 mm/h (OR=10,0 (1,78–51,2), p=0,009), lymphocyte count ≤ 21,5% (OR=53,7 (5,59–515), p=0,001), CRP ≥ 7,95 mg/L (OR=10,0 (1,78–56,1), p=0,009), WBC count ≥ 8,90 thousand/µL (OR=38,5 (4,15–356), p= 0,001), hemoglobin concentration ≤ 122 g/l (OR=8,14 (1,47–45,2), p=0,02). Summary/Conclusion: Current treatment options for Hodgkin’s lymphoma are mostly effective, but may have a negative pronounced damaging effect on some organs. Secondary osteoporosis in patients with HL is a well-known problem for the medical community, but has not been fully investigated. Our model for predicting the risk of decreased BMD in patients with HL combines the main pathogenetic mechanisms linking osteoporosis and HL. Keywords: Late effects, Hodgkin’s lymphoma, Hodgkin’s disease